Compliance Requirements

In December of 2020 Congress passed into law the Consolidated Appropriations Act (CAA of 2021).  As a portion of this bill, Insurers and Plans must submit cost data on pharmacy benefits and drug costs annually.  The stated intent of this reporting is to ensure the departments have sufficient information regarding prescription drugs to fully understand where plan assets are being spent.

Unfortunately, as you dig into this reporting requirement you quickly discover the reporting requires not only prescription drug spend data but also other data items that the TPA doesn’t even have such as employee contribution, manufacturer assistance program reimbursements and other various plan sponsors costs.

The reporting must be made on an annual basis calculating claim spend for all claims incurred for days of the calendar year that were paid by the plan by the last day of the March the following year.  

Plan sponsors must report for calendar years 2020 and 2021 no later than December 27th, 2022.  Plan sponsors must also report for the 2022 calendar year by June of 2023.

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About Us

Healthcare Reporting was founded in 2015 to address new compliance regulations required under the Affordable Care Act.  Over the years the compliance burden has continued to grow and our organization has evolved to meet the needs of our clients and partners.  Our solutions have been developed from the collective wisdom of dozens of healthcare professionals who have worked in a myriad of different roles across the entire healthcare delivery system. 

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